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Abdoh MG, Ajlan B, Basurrah AA, Al-Saiari S, Mujtaba SS, Rawah E, Brinji Z, Atteiah A, Farag AA. Primary Calvarial Lymphoma: A Case Report. Cureus 2024; 16:e55210. [PMID: 38558616 PMCID: PMC10981205 DOI: 10.7759/cureus.55210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
Calvarial lymphoma is radiologically similar in many respects to meningiomas, solid fibrous tumours, osteomyelitis, and metastatic carcinomas. Even though it is an extremely rare phenomenon, the initial suspicion and detection of calvarial lymphoma are paramount to establishing a correct diagnosis which helps to determine an appropriate management strategy. We present an illustrative rare case of primary calvarial lymphoma along with a literature review focusing on the best management strategy for this rare entity. A 45-year-old female presented to our center in March 2022. She had a history of forehead swelling, which was progressively increasing in size over time. The metastatic workup and bone marrow biopsy were negative. Initially, extensive surgery was planned to resect the lesion, but after a discussion with the multidisciplinary team, a biopsy of the lesion was taken, which revealed a large B-cell lymphoma. It is prudent to consider calvarial lymphoma in the differential diagnosis of a progressively growing skull lesion, which may obviate the need for large resective surgery. A biopsy plus chemoradiation may be all that is required.
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Affiliation(s)
- Mohammad G Abdoh
- Neurosurgery Department, King Abdullah Medical City, Makkah, SAU
| | - Balgees Ajlan
- Neurosurgery Department, Dalhousie University, Halifax, Nova Scotia, CAN
| | | | | | | | - Elham Rawah
- Radiology Department, King Abdullah Medical City, Makkah, SAU
| | - Zaina Brinji
- Radiology Department, King Abdullah Medical City, Makkah, SAU
| | | | - Ahmed A Farag
- Neurosurgery Department, King Abdullah Medical City, Makkah, SAU
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Nitta N, Moritani S, Fukami T, Nozaki K. Characteristics of cranial vault lymphoma from a systematic review of the literature. Surg Neurol Int 2022; 13:231. [PMID: 35855149 PMCID: PMC9282819 DOI: 10.25259/sni_28_2022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 05/06/2022] [Indexed: 11/18/2022] Open
Abstract
Background: Cranial vault lymphomas are rare and their clinical features are often similar to those of cranial vault meningiomas. The objective of this review was to identify the features helpful for differentiating lymphomas of the cranial vault, from meningiomas which were the most common diagnosis before the definitive pathological diagnosis. Methods: The inclusion criterion was a histologically proven malignant lymphoma initially appearing in the calvarium. We conducted a literature search of the electronic PubMed and Ichushi-Web databases up to June 1, 2020. Cranial vault lymphoma that was diagnosed after an original diagnosis of lymphoma in a nodal or soft-tissue site was excluded from the study. Descriptive analyses were used to present the patient characteristics. Results: A total of 111 patients were found in 98 eligible articles. Almost all studies were case reports. The most common symptom was a growing subcutaneous scalp mass (84%) present for a mean duration of 5.9 months before the patient presented for treatment in analyzable cases; this fast growth may distinguish lymphomas from meningiomas. The tumor vascularization was often inconspicuous or poor, unlike well-vascularized meningiomas. A disproportionately small amount of skull destruction compared with the soft-tissue mass was observed in two-thirds of the analyzable cases. Conclusion: This qualitative systematic review identified several features of cranial vault lymphomas that may be useful in differentiating them from meningiomas, including a rapidly growing subcutaneous scalp mass, poor vascularization, and limited skull destruction relative to the size of the soft-tissue mass.
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Affiliation(s)
- Naoki Nitta
- Departments of Neurosurgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Suzuko Moritani
- Clinical Laboratory Medicine and Division of Diagnostic Pathology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Tadateru Fukami
- Departments of Neurosurgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Kazuhiko Nozaki
- Departments of Neurosurgery, Shiga University of Medical Science, Otsu, Shiga, Japan
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Setta K, Beppu T, Sato Y, Saura H, Nomura J, Sugai T, Ogasawara K. Primary Cranial Vault Lymphoma Extending between Subcutaneous Tissue and Brain Parenchyma without Skull Destruction after Mild Head Trauma: A Case Report and Literature Review. Case Rep Oncol 2021; 14:1118-1123. [PMID: 34413742 PMCID: PMC8339476 DOI: 10.1159/000516272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 03/30/2021] [Indexed: 11/22/2022] Open
Abstract
Malignant lymphoma of the head rarely arises outside of the brain parenchyma as primary cranial vault lymphoma (PCVL). A case of PCVL that invaded from subcutaneous tissue into the brain, passing through the skull, and occurred after mild head trauma is reported along with a review of the literature. The patient was a 75-year-old man with decreased activity. One month before his visit to our hospital, he bruised the left frontal area of his head. Magnetic resonance imaging showed homogeneously enhanced tumors with contrast media in the subcutaneous tissue corresponding to the head impact area and the cerebral parenchyma, but no obvious abnormal findings in the skull. A biopsy with craniotomy was performed under general anesthesia. The pathological diagnosis was diffuse large B-cell lymphoma. On histological examination, tumor cells grew aggressively under the skin. Tumor cells invaded along the emissary vein into the external table without remarkable bone destruction and extended across the skull through the Haversian canals in the diploe. Tumor cells were found only at the perivascular areas in the dura mater and extended into the brain parenchyma. Considering the history of head trauma and the neuroimaging and histological findings, the PCVL in the present case arose primarily under the skin, passed though the skull and dura mater, and invaded along vessels and reached the brain.
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Affiliation(s)
- Kengo Setta
- Department of Neurosurgery, Iwate Medical University, Yahaba, Japan
| | - Takaaki Beppu
- Department of Neurosurgery, Iwate Medical University, Yahaba, Japan
| | - Yuichi Sato
- Department of Neurosurgery, Iwate Medical University, Yahaba, Japan
| | - Hiroaki Saura
- Department of Neurosurgery, Iwate Medical University, Yahaba, Japan
| | - Junichi Nomura
- Department of Neurosurgery, Iwate Medical University, Yahaba, Japan
| | - Tamotsu Sugai
- Department of Molecular Diagnostic Pathology, Iwate Medical University, Yahaba, Japan
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Toyota E, Taslimi S, Alkins R. Optimal Management of Calvarial Lymphoma: A Meta-Analysis. World Neurosurg 2021; 151:e484-e494. [PMID: 33901734 DOI: 10.1016/j.wneu.2021.04.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Calvarial lymphoma is an exceedingly rare phenomenon; the clinical presentation and imaging pattern mimic many diseases of the central nervous system. Several treatment approaches have been undertaken with variable use of surgery plus adjuvant chemotherapy and radiation; an optimal treatment algorithm has yet to be defined. The aim of this study was to better characterize management strategies and patient outcomes. METHODS An illustrative case was presented and a meta-analysis was carried out in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. MEDLINE and Embase were searched for cases of calvarial lymphoma. Outcomes between patients who underwent open surgery and biopsy only were compared directly. RESULTS In an analysis from 1976 to 2019, 62 patients with a median age of 60 were included. The most common presentations were subcutaneous scalp mass (89%), headaches (26%), and focal neurological deficits (21%). Osteolytic changes on computed tomography were seen in 69% of patients with extension into either the intracranial or extracranial space in 97% of cases. Surgical excision was performed in 41 patients with a remission rate of 85% and a recurrence rate of 5%, which did not vary significantly from patients treated nonsurgically (remission in 75%, P = 0.479; recurrence in 0%, P = 1.000) CONCLUSIONS: In patients presenting with a progressively enlarging scalp mass, calvarial lymphoma should be in the differential diagnosis, as it can be effectively managed with a biopsy followed by chemotherapy and radiation. The role for open surgery may be limited.
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Affiliation(s)
- Eric Toyota
- Division of Neurosurgery, Department of Surgery, Kingston Health Sciences Centre, Queen's University, Kingston.
| | - Shervin Taslimi
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Ryan Alkins
- Division of Neurosurgery, Department of Surgery, Kingston Health Sciences Centre, Queen's University, Kingston
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Huang J, Tang D, Xu Y, Wang X, Yu C, Dong Y. Head trauma complicated with primary cranial vault lymphoma: A case report. Medicine (Baltimore) 2019; 98:e14465. [PMID: 30762761 PMCID: PMC6407994 DOI: 10.1097/md.0000000000014465] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 01/07/2019] [Accepted: 01/15/2019] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Primary cranial vault lymphoma (PCVL) is an extremely rare extranodal lymphoma in the skull. This case study investigates the clinical features, so as to improve the understanding of the diagnosis and therapy. PATIENT CONCERNS A 31-year-old male presented painful scalp mass at the site of 1-month-old head trauma. DIAGNOSIS The final diagnosis was plasma cell lymphoma, which is a rare subtype of diffuse large B-cell lymphoma based on biopsy and immunohistochemistry findings. INTERVENTIONS The patient received total tumor resection in combination with chemotherapy OUTCOMES:: The patient survived without signs of systemic dissemination for 12 months after surgery at the time of last follow-up. LESSONS Trauma may be one of the factors that induce PCVL. The final diagnosis of PCVL depends on pathology and immunohistochemistry findings. A combined treatment of surgery, chemotherapy, and radiotherapy can achieve favorable outcomes.
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Affiliation(s)
- Jie Huang
- Department of Radiology, The Second Affiliated Hospital of Dalian Medical University, Dalian
- Department of Radiology, Hangzhou Normal University Affiliated Hospital, Hangzhou
| | - Dong Tang
- Department of Radiology, Hangzhou Normal University Affiliated Hospital, Hangzhou
| | - Yan Xu
- Department of Pathology, Dalian Jinzhou First People's Hospital, Dalian, China
| | - Xuna Wang
- Department of Radiology, The Second Affiliated Hospital of Dalian Medical University, Dalian
| | - Chuanwen Yu
- Department of Radiology, The Second Affiliated Hospital of Dalian Medical University, Dalian
| | - Yang Dong
- Department of Radiology, The Second Affiliated Hospital of Dalian Medical University, Dalian
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Primary Occipital Ewing's Sarcoma with Subsequent Spinal Seeding. Case Rep Pediatr 2017; 2017:1521407. [PMID: 28690908 PMCID: PMC5485299 DOI: 10.1155/2017/1521407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 05/01/2017] [Accepted: 05/23/2017] [Indexed: 11/18/2022] Open
Abstract
Ewing's sarcoma is a primary bone cancer that mainly affects the long bones. This malignancy is particularly common in pediatric patients. Primary cranial involvement accounts for 1% of cases, with occipital involvement considered extremely rare. In this case study, primary occipital Ewing's sarcoma with a posterior fossa mass and subsequent relapse resulting in spinal seeding is reported. A 3-year-old patient presented with a 1-year history of left-sided headaches, localized over the occipital bone with progressive torticollis. Computed tomography (CT) imaging showed a mass in the left posterior fossa compressing the brainstem. The patient then underwent surgical excision followed by adjuvant chemoradiation therapy. Two years later, the patient presented with severe lower back pain and urinary incontinence. Whole-spine magnetic resonance imaging (MRI) showed cerebrospinal fluid (CSF) seeding from the L5 to the S4 vertebrae. Primary cranial Ewing's sarcoma is considered in the differential diagnosis of children with extra-axial posterior fossa mass associated with destructive permeative bone lesions. Although primary cranial Ewing's sarcoma typically has good prognosis, our patient developed metastasis in the lower spine. Therefore, with CNS Ewing's sarcoma, screening of the entire neural axis should be taken into consideration for early detection of CSF seeding metastasis in order to decrease the associated morbidity and mortality.
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Intracranial multiple myeloma may imitate subdural hemorrhage: How to overcome diagnostic limitations and avoid errors in treatment. Neurol Neurochir Pol 2017; 51:252-258. [DOI: 10.1016/j.pjnns.2017.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 02/23/2017] [Indexed: 10/19/2022]
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Nittby HR, Bjartmarz H. A Subgaleal Hematoma That Turned Out to Be a B-Cell Lymphoma. World Neurosurg 2016; 93:489.e7-9. [PMID: 27368504 DOI: 10.1016/j.wneu.2016.06.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 06/19/2016] [Accepted: 06/20/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Subgaleal masses are relatively common in the clinical praxis, and after a trauma to the head, a subgaleal hematoma is usually suspected. However, other differential diagnoses, such as malignant tumors, should be kept in mind despite a history of a previous trauma. CASE DESCRIPTION AND CONCLUSIONS We report a case of a subgaleal mass that was clinically and radiologically diagnosed as a subgaleal hematoma in a patient on antiplatelet therapy. The patient had a history of trauma to her head, but pathologic examination after surgery unexpectedly showed a malignant B-cell lymphoma. A review of the literature is also presented.
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Affiliation(s)
| | - Hjalmar Bjartmarz
- Department of Neurosurgery, Lund University and Skåne University Hospital in Lund, Lund, Sweden
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Catana D, Koziarz A, Cenic A, Nath S, Singh S, Almenawer SA, Kachur E. Subdural Hematoma Mimickers: A Systematic Review. World Neurosurg 2016; 93:73-80. [PMID: 27268313 DOI: 10.1016/j.wneu.2016.05.084] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 05/24/2016] [Accepted: 05/25/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND A variety of subdural pathologies that may mimic hematomas are reported in the literature. We aimed to identify the atypical clinical and radiologic presentations of subdural masses that may mimic subdural hematomas. METHODS A systematic review of MEDLINE and Embase was conducted independently by 2 reviewers to identify articles describing subdural hematoma mimickers. We also present a patient from our institution with a subdural pathology mimicking a subdural hematoma. We analyzed patient clinical presentations, underlying pathologies, radiologic findings, and clinical outcomes. RESULTS We included 43 articles totaling 48 patients. The mean ± SD patient age was 55.7 ± 16.8 years. Of the 45 cases describing patient history, 13 patients (27%) had a history of trauma. The underlying pathologies of the 48 subdural collections were 10 metastasis (21%), 14 lymphoma (29%), 7 sarcoma (15%), 4 infectious (8%), 4 autoimmune (8%), and 9 miscellaneous (19%). Findings on computed tomography (CT) scan were 18 hyperdense (41%), 11 hypodense (25%), 9 isodense (20%), 3 isodense/hyperdense (7%), and 3 hypodense/isodense (7%). Thirty-four patients (71%) were treated surgically; among these patients, 65% had symptom resolution. Neither the pathology (P = 0.337) nor the management strategy (P = 0.671) was correlated with improved functional outcomes. CONCLUSIONS Identification of atypical history and radiologic features should prompt further diagnostic tests, including magnetic resonance imaging (MRI), to elucidate the proper diagnosis, given that certain pathologies may be managed nonsurgically. A subdural collection that is hyperdense on CT scan and hyperintense on T2-weighted MRI, along with a history of progressive headache with no trauma, may raise the suspicion of an atypical subdural pathology.
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Affiliation(s)
- Dragos Catana
- Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada
| | - Alex Koziarz
- Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada
| | - Aleksa Cenic
- Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada
| | - Siddharth Nath
- Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada
| | - Sheila Singh
- Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada
| | - Saleh A Almenawer
- Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada.
| | - Edward Kachur
- Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada
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Gheorghe G, Radu O, Milanovich S, Hamilton RL, Jaffe R, Southern JF, Ozolek JA. Pathology of central nervous system posttransplant lymphoproliferative disorders: lessons from pediatric autopsies. Pediatr Dev Pathol 2013; 16:67-73. [PMID: 23286282 DOI: 10.2350/12-01-1148-oa.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Posttransplant lymphoproliferative disorders (PTLD) involving the central nervous system (CNS) in children are uncommon and can prove diagnostically challenging. The clinical and imaging characteristics of CNS PTLD can overlap with those of infection, hemorrhage, and primary CNS tumors. Some cases of CNS PTLD remain clinically unsuspected and are diagnosed postmortem. We report 6 instances of CNS PTLD in children, 2 of which were limited to the CNS and were unsuspected before autopsy. In our autopsy series, PTLD was found outside the CNS in 4 out of 6 cases. Since CNS PTLD has a poor prognosis and the presentation can be subtle, unsuspected, and high grade, it is important to maintain a high index of suspicion and to perform imaging and brain biopsy whenever clinically appropriate. In the presence of leptomeningeal involvement, the diagnosis could be made by cerebral spinal fluid examination.
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Affiliation(s)
- Gabriela Gheorghe
- Department of Pathology, Children's Hospital of Wisconsin, Medical College of Wisconsin, 9000 West Wisconsin Avenue, Milwaukee, WI 53226, USA.
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Primary lymphoma of the cranial vault: case report and a systematic review of the literature. Acta Neurochir (Wien) 2012; 154:257-65; discussion 265. [PMID: 21842209 DOI: 10.1007/s00701-011-1124-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2011] [Accepted: 07/29/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND Bone involvement is a common finding in many types of lymphoma. Cranial vault involvement is extremely rare, and the majority of patients are found at staging to have concurrent disease in lymph nodes. Thirty-eight cases of primary lymphoma of the cranial vault have been reported to date. METHODS This article presents a rare case of primary cranial vault lymphoma and conducts a systematic review of the current literature. A total of 36 articles comprising 38 cases were included for analysis. The relevant demographic, clinical, and imaging characteristics, as well as the treatment and outcomes of this unique disease presentation were studied. RESULTS The average patient age was 60 years. There was no significant difference in patient gender. The predominant patient complaint was a subcutaneous scalp mass. Of the patients, 11.7% were immunocompromised. CT scans showed signs of osteolysis in 74% of lesions and hyperostosis in 5%, and the cranial vault was observed as normal in 18% of cases. MRI was performed in 23 cases. There was a wide range of histological subtypes, with a slight predominance of diffuse large B-cell lymphoma. Treatment consisted of surgery alone, surgery followed by radiotherapy, and surgery followed by radiotherapy and chemotherapy. The follow-up periods ranged from 5 months to 6 years, with a median value of 7 months. Sixteen patients were followed up to 12 months; 13 of them were alive at 1 year from diagnosis. CONCLUSION Primary cranial vault lymphoma is an extremely rare finding. It should be considered in the differential diagnosis of scalp masses. Although the analysis of outcome of the reported cases is difficult because of the small number of occurrences of this entity and the variability of follow-up, a combination of surgery, radiotherapy, and chemotherapy seems to offer better outcomes.
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Cranial vault lymphoma: a systematic review of five patients. J Neurooncol 2010; 100:9-15. [DOI: 10.1007/s11060-010-0137-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2009] [Accepted: 01/25/2010] [Indexed: 11/29/2022]
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